What is it about?

The missing scope of rehabilitation therapy for women with breast cancer. Breast cancer is the most prevalent cancer amongst women but it has the highest survival rates amongst all cancer. Rehabilitation therapy of post-treatment effects from cancer and its treatment is needed to improve functioning and quality of life. This review investigated the range of methods for improving physical, psychosocial, occupational, and social wellbeing in women with breast cancer after receiving breast cancer surgery. A search for articles published in English between the years 2009 and 2014 was carried out using The Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, PubMed, and ScienceDirect. Search terms included: ‘breast cancer’, ‘breast carcinoma’, ‘surgery’, ‘mastectomy’, ‘lumpectomy’, ‘breast conservation’, ‘axillary lymph node dissection’, ‘rehabilitation’, ‘therapy’, ‘physiotherapy’, ‘occupational therapy’, ‘psychological’, ‘psychosocial’, ‘psychotherapy’, ‘exercise’, ‘physical activity’, ‘cognitive’, ‘occupational’, ‘alternative’, ‘complementary’, and ‘systematic review’. Study selection: Systematic reviews on the effectiveness of rehabilitation methods in improving post-operative physical, and psychological outcomes for breast cancer were selected. Sixteen articles met all the eligibility criteria and were included in the review. Data extraction: Included review year, study aim, total number of participants included, and results. Data synthesis: Evidence for exercise rehabilitation is predominantly in the improvement of shoulder mobility and limb strength. Inconclusive results exist for a range of rehabilitation methods (physical, psycho-education, nutritional, alternative-complementary methods) for addressing the domains of psychosocial, cognitive, and occupational outcomes. Conclusion: There is good evidence for narrowly-focused exercise rehabilitation in improving physical outcome particularly for shoulder mobility and lymphedema. There were inconclusive results for methods to improve psychosocial, cognitive, and occupational outcomes. There were no reviews on broader performance areas and lifestyle factors to enable effective living after treatment. The review suggests that comprehensiveness and effectiveness of post-operative breast cancer rehabilitation should consider patients’ self-management approaches towards lifestyle redesign, and incorporate health promotion aspects, in light of the fact that breast cancer is now taking the form of a chronic illness with longer survivorship years

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Why is it important?

numerous non medical issues faced by breast cancer survivors, not just medical issues. many are not yet addressed due to a lack of therapy workforce in developing countries. Today, patient self management is a critical approach to care, and more partnership collaboration is a win win situation for better therapeutic care services. ‘Holistic patient-care is really too important to be left solely to doctors’. The Medical hegemony in the developing countries must be terminated, in order for cost-effective, and direct, therapeutic service deliveries.

Perspectives

Comprehensive rehabilitation is critical as patients live longer, healed but not cured. The persistent after effects and long term effects must be addressed by a autonomous health care professionals. Thus. autonomy and role of rehabilitation therapists that have been left out for far too long, must be incorporated. Medical hegemony should stop for the wellbeing of patient care

Assoc Prof Siew Yim LOH
University malaya

Rehabilitation is an area where there is professional and direct interdisciplinary input between Occupational therapist, physio therapist and speech therapist, dietitians, pharmacist, oncologist, primary care physicians, gerontologist etc working collaboratively and cost effectively, contributing to QOL of cancer survivors.

Assoc Prof Dr. SIEW YIM LOH
University of Malaya

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This page is a summary of: Methods to improve rehabilitation of patients following breast cancer surgery: a review of systematic reviews, Breast Cancer Targets and Therapy, March 2015, Taylor & Francis, DOI: 10.2147/bctt.s47012.
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